EP1424970B1 - Entfernbare lungenreduktionsvorrichtungen und systeme - Google Patents

Entfernbare lungenreduktionsvorrichtungen und systeme Download PDF

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Publication number
EP1424970B1
EP1424970B1 EP02759335A EP02759335A EP1424970B1 EP 1424970 B1 EP1424970 B1 EP 1424970B1 EP 02759335 A EP02759335 A EP 02759335A EP 02759335 A EP02759335 A EP 02759335A EP 1424970 B1 EP1424970 B1 EP 1424970B1
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EP
European Patent Office
Prior art keywords
air passageway
lung
air
catheter
frame structure
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
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EP02759335A
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English (en)
French (fr)
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EP1424970A4 (de
EP1424970A2 (de
Inventor
Clifton A. Alferness
Hugo X. Gonzalez
David H. Dillard
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Spiration Inc
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Spiration Inc
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Publication date
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Priority to EP08022468A priority Critical patent/EP2078502A3/de
Publication of EP1424970A2 publication Critical patent/EP1424970A2/de
Publication of EP1424970A4 publication Critical patent/EP1424970A4/de
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Publication of EP1424970B1 publication Critical patent/EP1424970B1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12104—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in an air passage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12027—Type of occlusion
    • A61B17/12036—Type of occlusion partial occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
    • A61B17/12172—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure having a pre-set deployed three-dimensional shape
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0402—Special features for tracheal tubes not otherwise provided for
    • A61M16/0404—Special features for tracheal tubes not otherwise provided for with means for selective or partial lung respiration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2002/043—Bronchi

Definitions

  • the present invention is generally directed to a treatment of Chronic Obstructive Pulmonary Disease (COPD).
  • COPD Chronic Obstructive Pulmonary Disease
  • the present invention is more particularly directed to removable air passageway obstruction devices, and systems and methods for removing the devices.
  • COPD Chronic Obstructive Pulmonary Disease
  • COPD chronic obstructive pulmonary disease
  • COPD chronic obstructive pulmonary disease
  • Current treatments for COPD include the prevention of further respiratory damage, pharmacotherapy, and surgery. Each is discussed below.
  • Pharmacotherapy may include bronchodilator therapy to open up the airways as much as possible or inhaled ⁇ -agonists. For those patients who respond poorly to the foregoing or who have persistent symptoms, Ipratropium bromide may be indicated. Further, courses of steroids, such as corticosteroids, may be required. Lastly, antibiotics may be required to prevent infections and influenza and pheumococcal vaccines may be routinely administered. Unfortunately, there is no evidence that early, regular use of pharmacotherapy will alter the progression of COPD.
  • Improvements in pulmonary function after LVRS have been attributed to at least four possible mechanisms. These include enhanced elastic recoil, correction of ventilation/perfusion mismatch, improved efficiency of respiratory muscaulature, and improved right ventricular filling.
  • lung transplantation is also an option.
  • COPD is the most common diagnosis for which lung transplantation is considered. Unfortunately, this consideration is given for only those with advanced COPD. Given the limited availability of donor organs, lung transplant is far from being available to all patients.
  • Both of these new therapies provide lung size reduction by permanently collapsing at least a portion of a lung.
  • a lung may be collapsed by obstructing an air passageway communicating with the lung portion to be collapsed.
  • the air passageway may be obstructed by placing an obstructing member in the air passageway.
  • the obstructing member may be a plug-like device which precludes air flow in both directions or a one-way valve which permits air to be exhaled from the lung portion to be collapsed while precluding air from being inhaled into the lung portion.
  • the lung portion may be collapsed by inserting a conduit into the air passageway communicating with the lung portion to be collapsed.
  • An obstruction device such as a one-way valve is then advanced down the conduit into the air passageway.
  • the obstruction device is then deployed in the air passageway for sealing the air passageway and causing the lung portion to be collapsed.
  • a lung constriction device including a sleeve of elastic material is configured to cover at least a portion of a lung.
  • the sleeve has a pair of opened ends to permit the lung portion to be drawn into the sleeve. Once drawn therein, the lung portion is constricted by the sleeve to reduce the size of the lung portion.
  • the therapies may be combined for more effective treatment. More specifically, it has been proposed that the therapies could be administered in series, with the first mentioned therapy first applied acutely for evaluation of the effectiveness of lung size reduction in a patient and which lung portions should be reduced in size to obtain the best results.
  • the first therapy is ideal for this as it is noninvasive and could be administered in a physician's office.
  • the invention provides device for reducing the size of a lung comprising an obstructing structure dimensioned for insertion into an air passageway communicating with a portion of the lung to be reduced in size, the obstructing structure having an outer dimension which is so dimensioned when deployed in the air passageway to preclude air from flowing into the lung portion to collapse the portion of the lung for reducing the size of the lung, the obstructing structure being collapsible to permit removal of the obstruction device from the air passageway.
  • the invention further provides an assembly comprising a device for reducing the size of a lung, the device being dimensioned for insertion into an air passageway communicating with a portion of the lung to be reduced in size, the device having an outer dimension which is so dimensioned when deployed in the air passageway to preclude air from flowing into the lung portion to collapse the portion of the lung for reducing the size of the lung, a catheter having an internal lumen and being configured to be passed down a trachea, into the air passageway, and a retractor dimensioned to be passed down the internal lumen of the catheter, seizing the device, and pulling the obstruction device proximally into the internal lumen to remove the device from the air passageway.
  • the device is collapsible after having been deployed to permit the device to be pulled proximally into the internal lumen of the catheter by the retractor.
  • the invention further provides a method of removing a deployed air passageway obstruction device from an air passageway in which the device is deployed.
  • the method includes the steps of passing a catheter, having an internal lumen, down a trachea and into the air passageway, advancing a retractor down the internal lumen of the catheter to the device, seizing the device with the retractor, collapsing the device to free the device from deployment in the air passageway, and pulling the device with the retractor proximally into the internal lumen of the catheter.
  • the invention still further provides an air passageway obstruction device comprising a frame structure, and a flexible membrane overlying the frame structure.
  • the frame structure is collapsible upon advancement of the device into the air passageway, expandable into a rigid structure upon deployment in the air passageway whereby the flexible membrane obstructs inhaled air flow into a lung portion communicating with the air passageway, and re-collapsible upon removal from the air passageway.
  • the invention still further provides an air passageway obstruction device comprising frame means for forming a support structure, and flexible membrane means overlying the support structure.
  • the frame means is expandable to an expanded state within an air passageway to position the membrane means for obstructing air flow within the air passageway and is collapsible for removal of the device from the air passageway.
  • FIG. 1 is a simplified sectional view of a thorax illustrating a healthy respiratory system
  • FIG. 2 is a sectional view similar to FIG. 1 but illustrating a respiratory system suffering from COPD and the execution of a first step in treating the COPD condition in accordance with the present invention
  • FIG. 3 is a perspective view, illustrating the frame structure of a removable air passageway obstruction device embodying the present invention
  • FIG. 4 is a perspective view of the complete air passageway obstruction device of FIG. 3 ;
  • FIG. 5 is an end view of the device of FIG. 3 illustrating its operation for obstructing inhaled air flow
  • FIG. 6 is another end view of the device of FIG. 3 illustrating its operation for permitting exhaled air flow
  • FIG. 7 is a perspective view of the device of FIG. 3 , illustrating its operation for permitting partial exhaled air flow;
  • FIG. 8 is a side view illustrating a first step in removing the device of FIG. 3 in accordance with one embodiment of the present invention.
  • FIG. 9 is another side view illustrating the collapse of the device of FIG. 3 as it is removed from an air passageway;
  • FIG. 10 is a side view illustrating an initial step in the removal of the device of FIG. 3 in accordance with another embodiment of the present invention.
  • FIG. 11 is a side view illustrating engagement of the frame structure of the device with a catheter during removal of the device
  • FIG. 12 is a side view illustrating the collapse of the device by the catheter during removal of the device
  • FIG. 13 is a side view of another air passageway obstruction device embodying the present invention during an initial step in its removal from an air passageway;
  • FIG. 14 is another side view of the device of FIG. 13 illustrating its collapse during removal from the air passageway;
  • FIG. 15 is a perspective view of the frame structure of another removable air passageway obstruction device embodying the present invention.
  • FIG. 16 is a cross-sectional side view of the device of FIG. 15 shown in a deployed state
  • FIG. 17 is a perspective side view of the device of FIG. 15 shown in a deployed state
  • FIG. 18 is a side view illustrating an initial step in removing the device of FIG. 15 from an air passageway
  • FIG. 19 is a side view illustrating an intermediate step in the removal of the device of FIG. 15 ;
  • FIG. 20 is a side view illustrating the collapse of the device of FIG. 15 during its removal from an air passageway.
  • FIG. 1 it is a sectional view of a healthy respiratory system.
  • the respiratory system 20 resides within the thorax 22 which occupies a space defined by the chest wall 24 and the diaphragm 26.
  • the respiratory system 20 includes the trachea 28, the left mainstem bronchus 30, the right mainstem bronchus 32, the bronchial branches 34, 36, 38, 40, and 42 and sub-branches 44, 46, 48, and 50.
  • the respiratory system 20 further includes left lung lobes 52 and 54 and right lung lobes 56, 58, and 60. Each bronchial branch and sub-branch communicates with a respective different portion of a lung lobe, either the entire lung lobe or a portion thereof.
  • air passageway is meant to denote either a bronchial branch or sub-branch which communicates with a corresponding individual lung lobe or lung lobe portion to provide inhaled air thereto or conduct exhaled air therefrom.
  • Characteristic of a healthy respiratory system is the arched or inwardly arcuate diaphragm 26.
  • the diaphragm 26 straightens to increase the volume of the thorax 22. This causes a negative pressure within the thorax.
  • the negative pressure within the thorax in turn causes the lung lobes to fill with air.
  • the diaphragm returns to its original arched condition to decrease the volume of the thorax.
  • the decreased volume of the thorax causes a positive pressure within the thorax which in turn causes exhalation of the lung lobes.
  • FIG. 2 illustrates a respiratory system suffering from COPD.
  • the lung lobes 52, 54, 56, 58, and 60 are enlarged and that the diaphragm 26 is not arched but substantially straight.
  • this individual is incapable of breathing normally by moving the diaphragm 28.
  • this individual in order to create the negative pressure in the thorax 22 required for breathing, this individual must move the chest wall outwardly to increase the volume of the thorax. This results in inefficient breathing causing these individuals to breathe rapidly with shallow breaths.
  • the apex portion 62 and 66 of the upper lung lobes 52 and 56, respectively are most affected by COPD.
  • COPD treatment or evaluation is initiated by feeding a conduit or catheter 70 down the trachea 28, into a mainstream bronchus such as the right mainstem bronchus 32, and into an air passageway such as the bronchial branch 42 or the bronchial sub-branch 50.
  • An air passageway obstruction device embodying the present invention is then advanced down an internal lumen 71 of the catheter 70 for deployment in the air passageway. Once deployed, the obstruction device precludes inhaled air from entering the lung portion to be collapsed.
  • the obstruction device take the form of a one-way valve.
  • the device In addition to precluding inhaled air from entering the lung portion, the device further allows air within the lung portion to be exhaled. This results in more rapid collapse of the lung portion.
  • obstruction devices which preclude both inhaled and exhaled air flow are contemplated as falling within the scope of the invention.
  • the catheter 70 is preferably formed of flexible material such as polyethylene. Also, the catheter 70 is preferably preformed with a bend 72 to assist the feeding of the catheter from the right mainstem bronchus 32 into the bronchial branch 42.
  • FIGS. 3 and 4 show an air passageway obstruction device 80 embodying the present invention.
  • the device 80 includes a proximal end 82 and a distal end 84.
  • the device 80 further includes a frame structure 86 including frame supports 88, 90, and 92.
  • Each of the frame supports has a shape to define a generally cylindrical center portion 94 and a pair of oppositely extending inwardly arcuate conical end portions 96 and 98.
  • the frame structure further includes a plurality of fixation members 100, 102, and 104 which extend distally from the proximal end 82.
  • the fixation members have the generally conical shape and terminate in fixation projections or anchors 106, 108, and 110 which extend radially outwardly.
  • the flexible membrane extends over the generally cylindrical and conical portions 94 and 98 defined by the frame structure. Hence, the flexible membrane is opened in the proximal direction.
  • the flexible membrane may be formed of silicone or polyurethane, for example. It may be secured to the frame structure in a manner known in the art such as by crimping, riveting, or adhesion.
  • the frame structure 86 and the device 80 are illustrated in FIGS. 3 and 4 as the device would appear when fully deployed in an air passageway.
  • the frame structure supports and frame structure fixation members are preferably formed of stainless steel or Nitinol or other suitable material which has memory of an original shape.
  • the frame structure permits the device to be collapsed for advancement down the internal lumen 71 of the catheter 70 into the air passageway where the device is to be deployed. Once the point of deployment is reached, the device is expelled from the catheter to assume its original shape in the air passageway. In doing so, the generally cylindrical portion 94 contacts the inner wall of the air passageway and the fixation projections 106, 108, and 110 pierce the wall of the air passageway for fixing or anchoring the device 80 within the air passageway.
  • FIGS. 5 and 6 show the valve action of the device 80 when deployed in an air passageway, such as the bronchial branch 42.
  • FIG. 5 is another view showing the device 80 during expiration with a portion 114 of the membrane 112 deflected inwardly.
  • FIGS. 8 and 9 illustrate a manner in which the device 80 may be removed from the air passageway 42 in accordance with one embodiment of the present invention. As previously mentioned, it may be desired to remove the device 80 if it is only used for evaluating the effectiveness of collapsing a lung portion or if it is found the more effective treatment may be had with the collapse of other lung portions.
  • the device 80 is shown in FIG. 8 in a fully deployed state.
  • the catheter 70 having the internal lumen 71 is advanced to the proximal end of the device 80.
  • the fixation members 102 and 104 define a larger conical radius than the frame supports 88 and 90.
  • the retractor may be used to pull the device into the internal lumen 71 of the catheter 70 causing the support structure and thus the device to collapse.
  • the collapsed device may now fully enter the internal lumen of the catheter for removal.
  • FIGS. 10-12 show another embodiment of the present invention for removing the device 80 from the air passageway 42.
  • the catheter 70 is fed down a bronchoscope 118 to the device 80.
  • the retractor takes the form of a forceps 120.
  • FIG. 10 it may be seen that the forceps has just engaged the proximal end 82 of the device 80.
  • the forceps 120 is held stationary while the catheter 70 is advanced distally so that the internal lumen 71 of the catheter 70 engages the fixation members 102 and 104. Further advancement of the catheter 70 as seen in FIG. 12 deflects the fixation projections 110 and 108 inwardly away from the inner wall of the air passageway 42.
  • the forceps may be used to pull the device 80 into the internal lumen 71 of the catheter 70 for removal of the device 80 from the air passageway 42.
  • FIGS. 13 and 14 show another removable air passageway obstruction device 130 and a method of removing it from an air passageway in accordance with the present invention.
  • the device 130 is shown in FIG. 13 deployed in the air passageway 42 and the catheter 70 is in ready position to remove the device 130 from the air passageway 42.
  • the device 130 is of similar configuration to the device 80 previously described.
  • the fixation members 136 and 138 are extensions of the frame supports 132 and 134, respectively.
  • the frame supports 132 and 134 cross at a pivot point 140 at the distal end 142 of the device 130. They extend distally and then are turned back at an acute angle to terminate at fixation or anchor ends 146 and 148.
  • the cylindrical portions of the support frame engage the inner wall of the air passageway 42 and the fixation points 146 and 148 project into the inner wall of the air passageway 42 to maintain the device in a fixed position.
  • the flexible membrane 150 extends from the dashed line 152 to the pivot or crossing point 140 of the frame supports 132 and 134 to form a one-way valve.
  • the frame structure of the device 130 is held stationary by a retractor within the catheter 70 and the catheter is advanced distally.
  • the catheter 70 engages the frame supports 132 and 134, the frame supports are deflected inwardly from their dashed line positions to their solid line positions.
  • This also causes the fixation members 136 and 138 to be deflected inwardly from their dashed line positions to their solid line positions in the direction of arrows 154.
  • These actions disengage the device 130 from the inner wall of the air passageway 42.
  • the retractor may pull the device into the internal lumen 71 of the catheter 70 for removal of the device 130 from the air passageway 42.
  • FIGS. 15-17 show a still further removable air passageway obstruction device 160 embodying the present invention.
  • the device 160 includes a plurality of frame supports 162, 164, 166, and 168.
  • the frame supports extend between a proximal ring 170 and a distal ring 172.
  • the device 160 is preferably laser cut from a sheet of Nitinol.
  • the support 164 includes a bend point 174 with a relatively long section 176 extending distally from the bend point 174 and a relatively short section 178 extending proximally from the bend point 174.
  • the short section 178 includes a fixation projection or anchor 180 extending slightly distally from the bend point 174.
  • FIGS. 16 and 17 show the device 160 in its deployed configuration.
  • the device When the device is deployed, it is advanced down a catheter to its deployment site in its collapsed state as shown in FIG. 15 .
  • the deployment site When the deployment site is reached, the device 160 is held outside of the catheter and the rings 170 and 172 are pulled toward each other. This causes the device to bend at the bend points of the frame supports. This forms fixation projections 180, 182, and 184 extending into the inner wall of the air passageway to fix the device in position.
  • the relatively long sections of the frame supports are covered with a flexible membrane 186 as shown in FIGS. 16 and 17 to form a one-way valve.
  • the valve functions as previously described to obstruct inhaled air flow but to permit exhaled air flow.
  • FIGS. 18-20 illustrate a manner of removing the device 160 from an air passageway.
  • a catheter 70 is advanced down a bronchoscope 118 to the device 160.
  • a retractor including a forceps 120 and pin 190 are advanced to the device.
  • the pin 190 carrying a larger diameter disk 192, extends into the device as the forceps 120 grasps the proximal ring 170 of the device 160.
  • the pin 190 continues to advance until the disk 192 engages the distal ring 172 of the device 160 as shown in FIG. 19 .
  • the pin 190 and disk 192 are advanced distally carrying the distal ring 172 distally.

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Claims (13)

  1. Vorrichtung (80,130, 160) zum Verringern der Größe einer Lunge, umfassend eine Obstruktionsstruktur, die zum Einbringen in einen Luftdurchgang (42) bemessen ist, der mit einem Bereich der in der Größe zu verringernden Lunge in Verbindung steht, wobei die Obstruktionsstruktur eine äußere Abmessung aufweist, die so bemessen ist, dass, wenn sie in dem Luftdurchgang (42) entfaltet ist Luft daran hindert in den Lungenbereich zu strömen, um den Bereich der Lunge zur Verringerung der Größe der Lunge zusammenfallen zu lassen,
    worin die Obstruktionsstruktur zusammengefaltet werden kann, um eine Entfernung der Obstruktionsvorrichtung (80, 130, 160) aus dem Luftdurchgang (42) zu gestatten, und
    worin die Obstruktionsstruktur eine Rahmenstruktur (86) und eine flexible Membran (112, 150, 186) umfasst, die über der Rahmenstruktur (86) liegt, wobei die Rahmenstruktur (86) auf ein Vorrücken der Vorrichtung (80, 130, 160) in dem Luftdurchgang (42) zusammengefaltet werden kann und auf ein Entfalten in dem Luftdurchgang (42) in eine steife Rahmenstruktur erweitert werden kann, worin die flexible Membran (112, 150, 186) einen inhalierten Luftstrom daran hindert in den in der Größe zu verringernden Bereich der Lunge zu strömen, dadurch gekennzeichnet, dass
    die Rahmenstruktur (86) die Rahmenstützen (88, 90, 92, 132, 134, 162, 164, 166, 168) umfasst, wobei jede der Rahmenstützen (88, 90, 92, 132, 134, 162, 164, 166, 168) eine Form aufweist, die allgemein ein Paar sich entgegengesetzt erstreckende, nach innen konische Endbereiche (94, 98, 176, 178) definieren.
  2. Vorrichtung (80, 130) nach Anspruch 1, worin jede der Rahmenstützen (88, 90, 92, 132, 134) eine Form aufweist, um einen allgemein zylindrischen Mittelbereich (94) und ein Paar sich entgegengesetzt erstreckender nach innen konischen Endbereiche (96, 98) zu definieren.
  3. Vorrichtung nach Anspruch 2, worin die Membran (112, 150) über der Rahmenstruktur (86) liegt diese teilweise umschließt und sich über den allgemeinen zylindrischen Bereich (94) und einen konischen Endbereich (98) erstreckt.
  4. Vorrichtung (160) nach Anspruch 1, worin sich die Rahmenstützen (162, 164, 166, 168) zwischen einem proximalen Ring (170) und einem distalen Ring (172) erstrecken und
    wobei jede Rahmenstütze (162, 164, 166, 168) eine Biegestelle (174) mit einem relativ langen Abschnitt (176) umfasst, der sich von der Biegestelle (174) distal erstreckt und eine relativ kurzen Abschnitt (178), der sich von der Biegestelle (174) proximal erstreckt.
  5. Die Vorrichtung nach Anspruch 4, worin der relativ lange Abschnitt (176) der Rahmenstützen (162, 164, 166, 168) mit der flexiblen Membran (186) bedeckt sind.
  6. Vorrichtung (80, 130, 160) nach einem der Ansprüche 1 bis 5, worin die Obstruktionsstruktur ein Einwegeventil bildet.
  7. Vorrichtung (80, 130, 160) nach einem der Ansprüche 1 bis 6 weiter umfassend mindestens einen Anker (106, 108, 110, 146, 148, 180, 182, 184), der die Vorrichtung (80, 130, 160) in dem Luftdurchgang (42) verankert, wenn die Vorrichtung (80, 130, 160) entfaltet wird und worin der mindestens eine Anker (106, 108, 110, 146, 148, 180, 182, 184) während eines Zusammenfaltens der Obstruktionsstruktur und eines Entfernens der Vorrichtung (80, 130, 160) aus dem Luftdurchgang (42) gelöst werden kann.
  8. Vorrichtung (80, 130, 160) nach Anspruch 7, worin die zusammenfaltbare Rahmenstruktur (86) mindestens einen Anker (106, 108, 110, 146, 148, 180, 182, 184) umfasst.
  9. Vorrichtung (80, 130, 160) nach einem der Ansprüche 1 bis 8, worin die flexible Membran (112, 150, 186) ein offenes proximales Ende und ein geschlossenes distales Ende aufweist.
  10. Vorrichtung (80, 130, 160) nach Anspruch 9, worin die flexible Membran (112, 150, 186) auf inhalierte Luft aufgebläht wird, um Luft daran zu hindern in den Lungenbereich zu strömen und auf ausgeatmete Luft zumindest teilweise Luft ablässt, damit Luft von dem Lungenbereich strömen kann.
  11. Anordnung, umfassend:
    eine Vorrichtung (80, 130, 160) nach einem der vorstehenden Ansprüche,
    einen Katheter (70), der ein inneres Lumen (71) aufweist, und so konfiguriert ist, dass er eine Trachea (28) hinab in den Luftdurchgang (42) gefiihrt werden kann, und
    eine zum Hinabführen in das innere Lumen (71) des Katheters (70) bemessene Aufziehvorrichtung, die die Vorrichtung (80, 130, 160) ergreift und die Obstruktionsvorrichtung (80, 130, 160) proximal in das innere Lumen (71) zieht, um die Vorrichtung (80, 130, 160) aus dem Luftdurchgang (42) zu entfernen,
    wobei die Vorrichtung (80, 130, 160), nachdem sie entfaltet wurde, zusammengefaltet werden kann, um der Vorrichtung (80, 130, 160) zu ermöglichen proximal in das innere Lumen (71) des Katheters (70) gezogen zu werden.
  12. Anordnung nach Anspruch 11, worin die Vorrichtung (80, 130, 160) durch den Katheter (70) zusammengefaltet werden kann, wenn die Vorrichtung (80, 130, 160) durch die Aufziehvorrichtung in das innere Lumen (71) des Katheters (70) gezogen wird.
  13. Anordnung nach Anspruch 11, worin die Aufziehvorrichtung Faltmittel zum Zusammenfalten der Vorrichtung (80, 130, 160) umfasst, bevor sie Vorrichtung (80, 130, 160) in das innere Lumen (71) des Katheters (70) gezogen wird.
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US8414655B2 (en) 2013-04-09
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US20050033310A1 (en) 2005-02-10
US8974484B2 (en) 2015-03-10
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US7757692B2 (en) 2010-07-20
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CA2459702A1 (en) 2003-03-20
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US20040206349A1 (en) 2004-10-21
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EP1424970A2 (de) 2004-06-09
US20040243140A1 (en) 2004-12-02
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